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Council to recommend review of community DNR rules as MOLST expands; PAs press for statutory clarity on MOLST certification
Summary
Council members agreed to draft a recommendation asking the commissioner to review potential conflicts between community DNR regulations and MOLST, noting the community DNR form dates to 1991; physician assistants said current statutes omit PAs from certification language even though PAs often complete MOLST forms in practice and are pursuing legislative fixes.
Members of the MOLST Advisory Council debated whether the community-based DNR regulatory program and MOLST can conflict in practice and concluded the commissioner’s office and the Office of Emergency Medical Services should review the issue.
"The form that goes with the orange bracelets has not been updated since 1991," one council member said, arguing the dated language and eligibility rules create confusion for clinicians and EMS. Members identified a narrow group of cases where a patient enrolled in the community DNR program might later execute a MOLST that authorizes CPR and noted that could amount to a written revocation of participation in the community DNR program if not made clear to EMS and hospital staff.
Council members discussed options ranging from an education-focused approach (train EMS and clinicians on how to reconcile documents) to recommending formal regulatory review and possible alignment or unification under a single oversight body. The chair said she would ask Rich Cayman (Office of Emergency Medical Services) to attend a future meeting to discuss whether regulatory changes or guidance are needed.
Separately, Nick, who identified himself as president-elect of the Connecticut Academy of PAs, said PAs routinely complete MOLST forms but that current statute omits PAs from the certification language that declares a patient eligible for MOLST. "PAs can execute the form... but technically, the way the statute is written, PAs cannot say that a patient is appropriate for a MOLST," he said, and the Academy is exploring a legislative fix this session. Members discussed coordinating testimony, the constraints of the short session (which ends in early May), and possible pathways for amendment, including adding friendly language to DPH's package if it would not jeopardize core agency priorities.
DPH staff agreed to share bill language and to coordinate with council members and legislative contacts about potential testimony and amendments.
Next steps: staff will invite the Office of Emergency Medical Services to a future meeting, draft a focused recommendation for the commissioner for council review, and circulate any bill language and hearing information when available.
